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Hypotensive effects following upper vs. lower body resistance exercise between normotensive and prehypertensive men.

ABSTRACT

Drouet PC, Archer DC, Munger CN, Coburn JW, Costa PB, Bottaro M, Brown LE. Hypotensive Effects Following Upper vs. Lower Body Resistance Exercise Between Normotensive and Prehypertensive Men. JEPonline 2017;20(2):17-27. The purpose of this study was to compare the effects of lower body resistance exercise (LBRE) and upper body resistance exercise (UBRE) on post-exercise hypotension (PEH) between normotensive (NT) men and prehypertensive (PHT) men. Twenty-four recreationally trained men performed UBRE and LBRE on 2 separate days followed by 60 min of quiet seated rest. Blood pressure was measured immediately post-exercise and every 10 min for 60 min thereafter. Systolic blood pressure (SBP) results demonstrated a group x time interaction where NT immediately post was higher than all other time points. For PHT, immediately post was higher than all other time points, and 50 and 60 min post were lower than rest. Diastolic blood pressure demonstrated a condition x time interaction where lower body immediately post was higher than all other time points, 30 min post was lower than 20 min post, and 50 min post was lower than 60 min post. For upper body, 10 min post was lower than rest, immediately post, 30, 40, 50, and 60 min post. Also, 20 min post was lower than rest, immediately post, 50, and 60 min. Post-exercise hypotension occurred for SBP in PHT men but not in NT men.

Key Words: Post-Exercise Blood Pressure

INTRODUCTION

Exercise has been used as a method to achieve, maintain, and improve health, fitness, and sports performance. Different methods of exercise such as aerobic and resistance training (RT) are used to achieve these goals. Understanding the physiological effects of exercise on the body is the key to ensuring safety, progression, and the benefits of exercise. Performance benefits achieved through exercise include increased maximal oxygen consumption ([VO.sub.2] max), muscular strength, endurance, and/or power.

Cardiovascular benefits of regular exercise include a reduction in resting blood pressure (BP) (31), which is critical in reducing the risk of cardiovascular disease (CVD) (7). Blood pressure is the pressure exerted against the arterial walls as blood is ejected from the heart (systolic blood pressure, SBP) and while the heart fills (diastolic blood pressure, DBP). Values are reported as SBP over DBP (i.e., SBP/DBP) and are measured in millimeters of mercury (mmHg). Classifications of BP according to the American Heart Association (2) are normotensive (NT, SBP less than 120 and DBP less than 80), prehypertensive (PHT, SBP 120-139 or DBP 80-89), hypertension stage 1 (SBP 140-159 or DBP, 90-99), hypertension stage 2 (SBP 160 or higher or DBP 100 or higher), and hypertensive crisis (SBP higher than 180 or SBP higher than 110).

Aerobic and RT exercises result in an acute increase in SBP that is usually sustained above resting values throughout the exercise (35). Immediately post-exercise, BP begins to return either to the resting values or values below resting (1,4-6,8,9,11-20,22-28,31-33). This decrease in BP below resting values post-exercise is termed post-exercise hypotension (PEH). Previous research has investigated this phenomenon due to the BP lowering benefits it provides post-exercise (29). The mechanism behind PEH is not fully understood. Prior studies have manipulated the type of aerobic exercise (1,4,11,13,20,22) to investigate the duration and magnitude of PEH. Studies have also investigated the use of different RT exercise protocols with the aim of identifying which protocol results in the greatest PEH (5,6,8,9,14-19,23-28,31-34). Manipulation of aerobic exercise intensity (11,20,22) and exercise type such as cycle and arm ergometry (1) have been investigated in NT (11,22) and PHT (20) individuals. Furthermore, the effects of PEH have been investigated in RT studies by manipulating volume (17,28), intensity (5), order of exercise (5), rest interval (4), and muscle mass (24,31) in NT, PHT, and hypertensive individuals.

Regarding muscle mass, Polito et al. (31) showed that the amount of muscle mass activated during resistance exercise has an influence on PEH in NT individuals. They reported a significant reduction in SBP after 10 sets of 10 reps of leg extension exercise when compared to elbow flexion exercise. Mohebbi et al. (24) also evaluated BP response during recovery after upper and lower body RT. Their results were different from the findings of Polito et al. (31). They reported that upper and lower body RT led to similar PEH in magnitude and duration in NT men, despite the exercises involving different muscle mass. It is clear that research regarding the effects of PEH is limited and controversial with regards to upper body exercise versus lower body exercise. In addition, to our knowledge, no studies have examined upper versus lower body RT exercise in NT and PHT men. Hence, the purpose of this study was to compare the effects of PEH between upper and lower body resistance exercises in NT and PHT male subjects.

METHODS

Subjects

Twenty-four NT (n = 13, age = 25.0 [+ or -] 4.2 yrs, height = 174.5 [+ or -] 6.6 cm, mass = 84.2 [+ or -] 17.4 kg, average resting SBP = 112.5 [+ or -] 4.7 mmHg, average resting DBP = 60.2 [+ or -] 6.4 mmHg) and PHT (n = 11, age = 24.3 [+ or -] 3.1 yrs, height = 179.5 [+ or -] 9.0 cm, mass = 94.6 [+ or -] 28.9 kg, average resting SBP = 127.6 [+ or -] 2.9 mmHg, average resting DBP = 66.2 [+ or -] 7.5) men with at least six months of resistance training experience exercising 2 times x [wk.sup.-1] volunteered to participate. Subjects were free from musculoskeletal injuries, had not been diagnosed with hypertension, and they were not taking any BP altering medications or using any form of diuretics. The subjects were categorized by their seated resting baseline BP as either NT or PHT in accordance with the American Heart Association guidelines (2). Subjects were excluded if their average resting BP exceeded the PHT range or if their resting BP classification changed between visits. Each session was scheduled at the same time of the day. All subjects were encouraged to maintain current dietary and hydration habits throughout the investigation. Furthermore, the subjects were told not to consume food or caffeine 4 hrs prior to each visit.

Procedures

On day one, the subjects were measured for height and mass using a stadiometer (752KL, Seca; Ontario, CA, USA) and a digital scale (ES200L; Ohaus Corporation Pinebrook, NJ, USA). Day one involved the assessment of resting BP followed by familiarization with the bench press and back squat exercises. Also, prior to 1-RM testing, the subjects performed an upper or lower body warm-up that consisted of resistance band exercises (upper body: seated band press and seated band row, lower body: band squat, and band knee curls) matched for 1-RM being completed. Then, using a counter balanced design, the subjects did 10 repetitions at 50% 1-RM for each exercise.

Resting Blood Pressure

Resting BP was assessed using a noninvasive automated sphygmomanometer (E-sphyg II, 9002DK-MCC, Hauppauge, NY, USA). The subjects remained seated for 20 min in a quiet area without distractions. Resting BP was measured in accordance with the recommended guidelines for assessment of BP in humans (30). Initial measurements were taken on both arms after 5 min to ensure no differences exist between arms. If a difference existed, the arm with the higher BP reading was used for all subsequent BP measurements. If no difference existed, the non-dominant arm was used for all subsequent BP measurements. At minute 15, two additional measurements were taken. Both measurements were separated by 1 min. The average of the two measurements represented their resting BP.

1-RM Assessment

Subjects were advised to use their natural grip position for all exercises. Bench press and back squat 1-RM assessments were performed on the same day separated by 15 min of rest. Prior to each 1-RM assessment subjects performed an upper or lower body warm-up. Then, the subjects gave an estimate of their 1-RM, and performed 8 repetitions at approximately 50% of their estimated 1-RM, followed by 3 repetitions at 70%. The following lifts were single repetitions of progressively heavier weights until failure, and 1-RM was reached (10). The subjects rested for 3 min between the warm-up sets, and 5 min between 1-RM attempts. Researchers communicated with the subjects and increased weight after successful 1-RM attempts. Once the subjects failed, their last completed lift represented their 1-RM. After a 15min rest, the second dynamic warm-up and 1-RM was completed using the same protocol and rest intervals. From the upper and lower body 1-RM results, the loads for the lat pull down, seated military press, knee extension, and knee curl exercises were estimated. The familiarization of each exercise was then conducted.

Upper and Lower Body Session

Each subject's resting BP was assessed using the same procedures as day one except the for 5 min measurement. Then, they performed the warm-up matched for the upper or lower body exercise for that day, which was followed by 4 sets of 6 repetitions of either upper body exercise (bench press, lat pull down, and seated military press) or lower body exercise (back squat, knee extension, and knee curl) using 75% of their 1-RM with 2 min rest between sets and 1 min rest between exercises. When the last set of exercise was completed, the subject sat quietly in a comfortable chair with the feet on the floor for a 60-min recovery period. Blood pressure was assessed immediately post-exercise and every 10 min during recovery.

Statistical Analyses

All analyses were performed with SPSS 21.0. A one-way ANOVA was used to analyze group differences in age, height, mass, average resting SBP, and average resting DBP. A 2 x 2 x 8 (group x condition x time) mixed factor ANOVA was used to analyze SBP and DBP. Interactions were evaluated followed by main effects. An alpha level was set at 0.05 to determine statistical significances.

RESULTS

For age, height, and mass, there were no differences between the NT subjects and the PHT subjects. The average resting BP, SBP, and DBP were greater in the PHT subjects versus the NT subjects. For SBP, there was no three-way interaction, but there was a significant (P<0.05) two-way interaction of group x time. Two follow up 1 x 8 ANOVA analyzed SBP over time, one for each group. For the NT group, SBP immediately post-exercise was significantly higher than at rest, 10, 20, 30, 40, 50, and 60 min post. No other time points were different (Table 1). For PHT, SBP immediately post was significantly higher than at rest, 10, 20, 30, 40, 50, and 60 min post. Also, 50 and 60 min post were significantly lower than the rest value. No other time points were different (Table 2).

For DBP, there was no three-way interaction, but there was a significant (P<0.001) two-way interaction of condition x time. Two follow up 1 x 8 ANOVA analyzed DBP over time, one for lower body and one for the upper body. For the lower body, DBP immediately post was significantly higher than at rest, 10, 20, 30, 40, 50, and 60 min post. Also, the 30 min post was significantly lower than the 20 min post, and the 50 min post was significantly lower than the 60 min post. No other time points were different (Tables 3). For the upper body, the 10 min post was significantly lower than rest, immediately post, 30, 40, 50, and 60 min post, and the 20 min post was significantly lower than rest, immediately post, 50 min, and the 60 min post. No other time points were different (Table 4).

DISCUSSION

The purpose of this study was to compare the effects of upper and lower body resistance exercise on PEH between NT and PHT men. The major findings were that SBP for PHT men at 50 and 60 min post-exercise was lower than their resting values regardless of the exercise type. Diastolic blood pressure at 10 and 20 min post was lower than rest for the UBRE, while no hypotensive effects were seen for the LBRE. A decrease in total peripheral resistance is likely the cause for the SBP hypotensive effect in the PHT subjects, as well as the DBP hypotensive effect following the UBRE.

Different hypotensive responses between the PHT and the NT subjects may be attributed to the differences in resting BP. Furthermore, responses between the upper and the lower body exercises could be attributed to the relative effort produced between the exercises. Effort generally equates to the percentage of 1-RM and the amount of muscle activated. Therefore, total peripheral resistance is influenced by the interaction between the sympathetic and parasympathetic nervous system during and following resistance exercise, as well as the hemodynamic effects of the resistance exercise.

Many mechanisms have been proposed to contribute to PEH following resistance exercise. Acute cardiovascular responses that alter the subjects' hemodynamics are the likely cause along with the decrease in total peripheral resistance, which is a primary contributor (8). However, reductions in peripheral resistance may also be due to a reduction in venous return or alteration in the vascular tone of the smooth muscles within the arteries and arterioles (6,8,16,17,19,21,29,33,35). Activation of the sympathetic and the parasympathetic nervous system mediates vasodilation and vasoconstriction, respectively, of the arteries and arterioles that affect the hemodynamics of the body. Also, a person's sitting position, myogenic autoregulation, and the release of vasodilating chemicals such as nitric oxide (NO), prostaglandins, and adenosine contribute to blood flow and pressure changes in the body (4-6,8,9,19,21,23,27,29,31,35).

Traditionally, resistance training involves the manipulation of critical variables to elicit gains in strength, hypertrophy, and power. This study used a traditional resistance training style for intensity and volume. Previous research findings that resulted from investigating PEH following resistance training are inconsistent. While the present study resulted in a SBP hypotensive effect for the PHT subjects, there were no hypotensive effects observed in the NT subjects. Furthermore, there was a DBP hypotensive effect 10 and 20 min post upper body exercise.

Several researchers (5,6,8,14,16,17,27,28,33) have reported SBP and/or DBP hypotensive effects after resistance exercise with intensities ranging from 60% to 80% 1-RM. Intensities within this range appear to be more effective at eliciting PEH than lower intensities, although Queiroz et al. (32) observed PEH with an intensity of 50%. While it has been suggested that high intensity resistance exercise can influence the magnitude and duration of PEH, Bentes et al. (5) and Neto and colleagues (27) found no differences in PEH between exercise intensities of 80%, 60%, and 20% for SBP and DBP. The current study demonstrated PEH for SBP and DBP with an intensity of 75%. This finding is similar to Macedo et al. (23) who reported PEH at 45 min post strength training at 80% 1-RM and 15 min post 65% 1-RM. Furthermore, our results at 75% 1-RM were similar to Duncan et al. (14) who used 80% 1-RM to elicit a SBP PEH response at 50 and 60 min post-exercise

Similar to Macedo et al. (23) who used 3 sets of 8 repetitions, the current study used 4 sets of 6 repetitions. The number of sets and repetitions play an important role in eliciting PEH, as Polito and Farinatti (31) demonstrated PEH following 10 sets at a 12-RM of a single lower body exercise, but not upper body, whereas PEH was not elicited following 6 sets of a single upper or lower body exercise. Perhaps, the lower volume of exercise did not provide the sufficient stimulus to elicit PEH. Furthermore, Figueiredo et al. (17) observed differences in PEH following 1, 3, and 5 sets of 8 exercises of which 5 sets demonstrated a greater duration and magnitude of PEH versus 1 or 3 sets. The findings in the present study with regards to systolic and diastolic PEH are consistent with the findings of Macedo et al. (23) and Figueiredo et al. (17) in which the use of moderate to high exercise volume resulted in PEH.

The present study used a traditional resistance training protocol because the majority of the recreational population of subjects appears to train in this manner. Manipulation of exercise type, free weight (14) or machines, single-joint or multi-joint, upper body or lower body, circuit training, and rest intervals are factors related to PEH. Machines can benefit individuals of all levels while free weights can provide added benefits that include increased neuromuscular coordination and activation of stabilizing muscles. There is speculation that muscle mass affects duration or magnitude of PEH (14,31), and that free weights result in similar PEH as machines but with reduced exercise volume (14). The current study incorporated compound exercises that involved multiple joints and activated large muscle groups.

In an attempt to isolate the effects of the upper versus the lower body exercises on PEH, the current study used a combination of free weights and machines similar to Rezk et al. (33). However, the subjects used only 3 exercises while the subjects in Rezk et al. (33) used 6 exercises. Polito and Farinatti (31) reported PEH in SBP following 10 sets of 10 repetitions of a 12-RM load of leg extensions. However, PEH was not observed following biceps curls using the same protocol. These dissimilarities between studies may be due to different intensity, volume, and type of exercise. We speculate that different hemodynamic responses between free weights and machines may have played a role. Increased centralized pressure following free weights can temporarily occlude blood flow that decreases venous return and preload, thus resulting in hemodynamic changes to maintain blood flow. Vasodilation of the arterioles through a process called myogenic autoregulation along with, perhaps gravitational forces following completion of an exercise overhead may have increased venous return and explain why the current study demonstrated diastolic PEH following UBRE but not following LBRE (27,35). Investigations by de Almeida et al. (12) showed that upper body arm crank and lower body cycle exercise both elicited a PEH in SBP. However, a PEH in DBP was only observed following upper body exercise, which is similar to the current study.

The current study revealed differences in PEH between the NT subjects and the PHT subjects at rest and following exercise. Fisher (18) reported no differences in PEH in SBP in normotensive and borderline hypertensive women following resistance exercise. Moraes et al. (25) showed significant PEH in systolic and diastolic BP in stage 1 hypertensives following circuit training at 60% 1-RM across 60 min of post-exercise rest. Our results are similar to Pescatello et al. (29) suggesting that a higher resting BP leads to PEH of greater magnitude and duration. Therefore, it could be possible that RT did not elicit PEH in NT men as a safety mechanism to maintain hemodynamic homeostasis.

CONCLUSIONS

Based on the results of the current study, PHT men demonstrated a SBP hypotensive effect following either UBRE or LBRE but NT men did not. Also, UBRE, but not LBRE led to a hypotensive effect following resistance exercise. Therefore, a combination of upper and lower body resistance exercise could provide an alternative for men who may be at risk for hypertension as a modality to lower resting SBP.

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Phillip C. Drouet (1), David C. Archer (1), Cameron N. Munger (1), Jared W. Coburn (1), Pablo B. Costa (1), Martim Bottaro (2), Lee E. Brown (1)

(1) California State University, Fullerton, Department of Kinesiology, Fullerton, CA, United States, (2) University of Brasilia, College of Physical Education, Brasilia, Brazil
Table 1. Normotensive SBP (mmHg) Across 60 Min Post-Exercise.

Conditions  Rest           IP                 10 MP

Lower       111.58         135.54             112.15
Body        [+ or -] 6.02  [+ or -] 8.17      [+ or -] 6.54
Upper       112.31         120.31             114.85
Body        [+ or -] 6.43  [+ or -] 14.91     [+ or -] 9.53
Total       111.94         127.92             113.50
            [+ or -] 5.83  [+ or -] 8.28 (#)  [+ or -] 6.54

Conditions  20 MP          30 MP           40 MP          50 MP

Lower       112.92         111.38          111.62         111.15
Body        [+ or -] 5.09  [+ or -] 6.73   [+ or -] 6.75  [+ or -] 6.99
Upper       112.54         116.31          116.85         114.69
Body        [+ or -] 9.96  [+ or -] 7.63   [+ or -] 7.73  [+ or -] 8.10
Total       112.73         113.85          114.23         112.92
            [+ or -] 6.30  [+ or -] 6.36   [+ or -] 4.74  [+ or -] 5.97

Conditions  60 MP

Lower       114.92
Body        [+ or -] 9.68
Upper       115.77
Body        [+ or -] 6.30
Total       115.35
            [+ or -] 6.68

(#) Higher than all other time points. Abbreviations: SBP = Systolic
Blood Pressure, IP = Immediately Post, 10 MP = 10 Min Post, 20 MP = 20
Min Post, 30 MP = 30 Min Post, 40 MP = 40 Min Post, 50 MP = 50 Min
Post, 60 MP = 60 Min Post

Table 2. Prehypertensive SBP (mmHg) Across 60 Min Post-Exercise.

Conditions  Rest           IP                 10 MP

Lower       126.00         144.73             125.27
Body        [+ or -] 3.90  [+ or -] 11.84     [+ or -] 8.93
Upper       128.00         137.82             121.45
Body        [+ or -] 5.63  [+ or -] 12.25     [+ or -] 9.27
Total       127.00         141.27             123.36
            [+ or -] 3.78  [+ or -] 6.86 (#)  [+ or -] 7.00

Conditions   20 MP         30 MP           40 MP

Lower       121.00         120.27          121.73
Body        [+ or -] 9.22  [+ or -] 10.14  [+ or -] 12.27
Upper       124.91         127.27          122.18
Body        [+ or -] 9.91  [+ or -] 6.03   [+ or -] 6.13
Total       122.95         123.77          121.95
            [+ or -] 7.53  [+ or -] 5.93   [+ or -] 7.73

Conditions  50 MP              60 MP

Lower       119.45             121.45
Body        [+ or -] 6.89      [+ or -] 10.28
Upper       124.00             120.09
Body        [+ or -] 9.77      [+ or -] 8.30
Total       121.73             120.77
            [+ or -] 6.85 (*)  [+ or -] 7.33 (*)

(#) Higher than all other time points. (*) Lower than rest.
Abbreviations: SBP = Systolic Blood Pressure, IP = Immediately Post, 10
MP = 10 Min Post, 20 MP = 20 Min Post, 30 MP = 30 Min Post, 40 MP = 40
Min Post, 50 MP = 50 Min Post, 60 MP = 60 Min Post.

Table 3. Lower Body DBP (mmHg) Across 60 Min Post-Exercise.

Group            Rest            IP                 10 MP

Normotensive     60.35           71.38              62.00
                 [+ or -] 7.84   [+ or -] 8.28      [+ or -] 7.16
Prehypertensive  67.05           74.73              64.45
                 [+ or -] 9.56   [+ or -] 7.23      [+ or -] 7.54
Total            63.42           72.92              63.13
                 [+ or -] 9.13   [+ or -] 7.83 (#)  [+ or -] 7.28

Group            20 MP           30 MP              40 MP

Normotensive     63.69           61.62              62.00
                 [+ or -] 8.46   [+ or -] 8.65      [+ or -] 6.42
Prehypertensive  67.36           64.45              68.27
                 [+ or -] 7.85   [+ or -] 8.44      [+ or -]11.52
Total            65.38           62.92              64.88
                 [+ or -] 8.22   [+ or -] 8.49 (@)  [+ or -] 9.45

Group            50 MP               60 MP

Normotensive     61.15               64.38
                 [+ or -] 8.82       [+ or -] 8.64
Prehypertensive  66.00               67.09
                 [+ or -] 6.96       [+ or -] 8.77
Total            63.38               65.63
                 [+ or -] 8.23 ($)   [+ or -] 8.62

(#) Higher than all other time points, (@) Lower than 20 Min Post,
($) Lower than 60 Min Post. Abbreviations: DBP = Diastolic Blood
Pressure, IP = Immediately Post, 10 MP = 10 Min Post, 20 MP = 20 Min
Post, 30 MP = 30 Min Post, 40 MP = 40 Min Post, 50 MP = 50 Min Post, 60
MP = 60 Min Post

Table 4. Upper Body DBP (mmHg) Across 60 Min Post-Exercise.

Group            Rest           IP              10 MP

Normotensive     60.85          62.77           59.00
                 [+ or -] 7.60  [+ or -] 10.01  [+ or -] 5.21
Prehypertensive  65.77          67.82           59.18
                 [+ or -] 7.25  [+ or -] 14.07  [+ or -] 12.48
Total            63.10          65.08           59.08
                 [+ or -] 7.70  [+ or -] 12.04  [+ or -] 9.05 (&)

Group            20 MP              30 MP          40 MP

Normotensive     58.77              61.92          60.54
                 [+ or -] 6.58      [+ or -] 8.10  [+ or -] 6.60
Prehypertensive  62.09              63.82          66.00
                 [+ or -] 8.12      [+ or -] 9.26  [+ or -] 9.01
Total            60.29              62.79          63.04
                 [+ or -] 7.36 (%)  [+ or -] 8.51  [+ or -] 8.11

Group            50 MP          60 MP

Normotensive     62.77          63.46
                 [+ or -] 7.15  [+ or -] 6.86
Prehypertensive  64.91          67.27
                 [+ or -] 8.54  [+ or -] 10.90
Total            63.75          65.21
                 [+ or -] 7.72  [+ or -] 8.94

(&) Lower than Rest, Immediately Post, 30, 40, 50, and 60 Min post,
(%) Lower than Rest, Immediately Post, 50 and 60 Min Post.
Abbreviations: DBP = Diastolic Blood Pressure, IP = Immediately Post,
10 MP = 10 Min Post, 20 MP = 20 Min Post, 30 MP = 30 Min Post, 40 MP =
40 Min Post, 50 MP = 50 Min Post, 60 MP = 60 Min Post
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Author:Drouet, Phillip C.; Archer, David C.; Munger, Cameron N.; Coburn, Jared W.; Costa, Pablo B.; Bottaro
Publication:Journal of Exercise Physiology Online
Article Type:Report
Date:Apr 1, 2017
Words:5149
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